Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there

Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there

Smith AK; McCarthy E; Weber E; Cenzer IS; Boscardin J; Fisher J; Covinsky K

Health Affairs

2012

Female; Hospitalization; Humans; Male; United States; Terminal Care; Terminally Ill; Hospital Mortality; Aged; Emergency Service; 80 and over; Hospital; Insurance Claim Review

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

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